MEDICARE: GEORGIA GROUP SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1952704942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA GROUP SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 740916
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0916
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 ROCKMART HWY
Second Line	:
City	:	CEDARTOWN
State	:	GA
Zip	:	30125-6029
Country	:	US
Telephone Number	:	770-748-2500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	KIM H LARSEN
Credential	:
Telephone Number	:	770-874-5400

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	02/05/2020

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